Two weeks ago was International Transgender Day of Visibility. Minus a few posts online by media outlets, little was said about it. As a public health student, I have been wondering how marginalized communities will be negatively affected by COVID-19 and how some communities’ needs will be overshadowed. As healthcare systems become overwhelmed, medical resources will be focused on treating coronavirus patients.

One of the communities that will undoubtedly face increased pressure is the transgender and non-binary community as a result of restrictive coronavirus lockdowns, disrupted access to social services, barriers to prescribing and managing hormone therapy medications and hospital decisions to halt gender-affirming surgeries. And in some ways, “stay-at-home” orders and enforced social distancing policies, while they effectively reduce opportunities for viral transmission, also contribute to trans erasure. They create more opportunities for the trans and non-binary communities to be ignored, denied or minimized. What isn’t seen isn’t heard. Only through increased visibility can people achieve equal rights.

With more than 40 states that have introduced anti-trans legislation this year, statewide “stay-at-home” orders and social distancing policies limit the ability for transgender activists to protest. Moreover, the media focus on COVID-19 developments might allow this type of legislation to fall through the cracks. A recent lawsuit filed against the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference and the boards of education in Bloomfield, Cromwell, Glastonbury, Canton and Danbury aimed to block transgender athletes from participating in girls’ sports. But it’s hard to give this any attention with all that’s going on around us.

Additionally, trans and non-binary workers are two to three times more likely to be unemployed compared to the general population, and a lack of employer-based insurance results in a coverage gap. The pandemic has only exacerbated existing disparities. The International Foundation for Employee Benefit Plans reported that transgender inclusive healthcare benefits are offered to less than one-third of U.S. employees. With widespread furloughing and unemployment in response to the pandemic, even those with insurance benefits that cover hormone replacement therapy (HRT), counselling or gender-affirming surgery are at risk of losing coverage. While over three million Americans filed for unemployment as a direct result of layoffs caused by COVID-19, applying for unemployment might create unique challenges for trans individuals.

And it is no secret that as a result of social stigma and discrimination, the transgender population has a higher rate of unstable housing and homelessness. According to the Williams Institute, over 30 percent of individuals served by drop-in centers, street outreach workers and housing programs identified as LGBT. Unfortunately, those who are transgender and homeless are at increased risk of exploitation, violence and abuse, and may be turned away from shelters as a result of their gender identities. As some homeless shelters close or limit occupancy to stop the spread of COVID-19, this further limits available housing options for unhoused transgender individuals.

Past negative experiences of being misgendered or refused service when seeking care may cause trans people to forego care. Already overburdened hospitals might not have the capacity to provide sufficient social services or hormone treatments. Furthermore, gender-confirmation surgeries, deemed non-essential and elective, have been delayed or cancelled at many U.S. hospitals due to the coronavirus. Interruptions in HRT provision or postponing long-awaited, gender-affirming surgeries could augment feelings of isolation and gender dysphoria and amplify psychological distress.

School closures might also pose unique challenges to transgender youth. With campus LGBTQ+ resource centers and peer support unavailable, and the suspension of all school-based social activities, transgender students might feel unsupported. Furthermore, self-quarantining with abusive family members who do not affirm their trans identity can be extremely traumatizing to trans youth.

As one trans commenter pointed out, “I have to make a decision about whether to stay in the UK where I study or fly back to the States to be with my parents, one of whom doesn’t use my name or pronouns and has refused to do so.”

Quarantine may also increase rates of domestic and intimate-partner violence perpetuated against transgender individuals. Lockdowns and social distancing policies, budget cuts to social services and mental health counseling and financial instability due to unemployment all create opportunities for abusers to perpetrate sexual violence. This may make it more difficult for transgender victims to leave abusive relationships or report abuse.

Elderly trans individuals at higher risk of contracting COVID-19 might refuse help from aging providers such as meal-delivery programs, senior centers or other social programs because they are afraid of harassment or discrimination. Moreover, trans individuals are more likely than the general population to smoke and to be diagnosed with cancer and HIV, putting them at a higher risk to contract coronavirus and face harsher symptoms.

Overall, the coronavirus has not just affected the trans and non-binary communities by restricting access to gender-affirming surgeries or HRT, but has effectively reduced their visibility. While COVID-19 has had a pronounced effect on everyone, those most vulnerable, such as those in the trans community, are poised to receive the most collateral damage.

RYAN SUTHERLAND is an MPH candidate at the Yale School of Public Health. Contact him at ryan.sutherland@yale.edu .